Do Italian housing regulations and policies protect poor people’s health?
Dear Editor,
As it often happens in Italy, at the end of the year the Government proposes a Law Decree (this year 192/2014) called “Milleproroghe”, meaning a thousand prorogations. The Decree consists in a melting pot of really heterogeneous measures that try to put a band-aid on different situations. Among the various resolutions, this year the Decree did not include a block of the evictions for low-income families, or fa-milies including disabled people or children.
Recently, the councillors for housing of the cities of Rome, Milan and Naples, the three largest urban areas in Italy, wrote a joint open letter in order to ask the Government to act to avoid a situation conside-red unmanageable from both a social and public order point of view (1). Once ejected from their present homes, the fate of those people is to occupy unhealthy, precarious dwellings, if any. We want therefore to emphasize that the availability of acceptable dwellings has a significant impact on health. Home envi-ronment is in fact one of the major determinants of health (2): in Italy people spend about 60% of their lifetime inside their houses, with slight variations depending on geographical area, environmental context and season (3).
Unhealthy, inadequate and improper dwellings appear to be a widespread issue in large urban areas of the country: we are mainly referring to the use of garrets, basements and semi basements, but also of buildings undergoing recoveries and amnesties, as well as, of course, those completely abusive. The last census of Italian residential buildings in the decade 2001-2011 (4) has recorded a huge increase (+ 131.8%) of precarious housing occupied by residents (shacks, caravans, cellars, etc.), which rose from 23,336 in 2001 to 54,094 in 2011. This phenomenon is particularly evident in the Southern part of the country, but does not spare any Italian region.
The inadequacy and degradation of housing, especially if precarious, expose the inhabitants to a variety of physical, chemical and biological agents, which include moisture and moulds, thermal discomfort, over-crowding, volatile organic compounds, radon gas, electromagnetic fields. It is well documented in interna-tional scientific literature that these exposures contribute to the emergence, or re-emergence, of pathological conditions such as asthma, cardiovascular and respiratory diseases, mental illness, cancer, tuberculosis (5).
The data presented by the above-mentioned councillors (1) include 30-50,000 families at risk, with 10,000 judgments for eviction in Rome, 4,500 in Naples and 4,000 in Milan; these numbers are also extremely alarming from a sanitary point of view, especially if one considers that about 70% of these households have requirements that, in previous “Milleproroghe” decrees, were considered sufficient for being entitled to an extension of the eviction.
The Government stated that the funds for supporting unguilty non-payers of rents were already ear-marked in the Law Decree n. 47/2014 (converted into Law n. 80/2014).
These are indeed very different measures, as the availability of funds provided by Decree 47/2014 will be deferred in time between 2014 and 2020, while the measures defined in Law Decree 192/2014 will be immediately applied. Furthermore, the amount of money expected by Law 80/2014 will provide only a partial answer to a cogent and growing problem, given the socio-economic crisis that is currently striking hard on Italy (6).
Health protection in indoor environment needs not only sanitary, but also social, administrative and normative interventions (7). Local building codes are outdated and heterogeneous, and subsequent dero-gations introduced at national, regional and local level, are a serious obstacle to promote and to preserve public health (8-10).
The Government in February changed its mind and deferred the evictions for 120 days for those fa-milies with major problems (11). Of course this can be only a temporary solution, and we hope that the Government will soon consider simplification and improvement of the regulations as a part of recovery and rehabilitation of social housing, valuing their health impact. We reckon that Italian lawmakers ought to consider the great impact not only in terms of health, but also of direct and indirect health-care costs caused by unhealthy living environments.
Lorenzo Capasso*, Stefano Capolongo*, Antonio Faggioli*, Maria Grazia Petronio, Daniela D’Alessandro*
* Working Group for Hygiene of Built Environment (Igiene Ambiente Costruito - IAC),
Italian Society of Hygiene, Preventive Medicine and Public Health (Società Italiana di Igiene, Medicina Preventiva e Sanità Pubblica - SItI)
References
1. www.repubblica.it/economia/2015/01/06/news/roma_milano_napoli_appello_al_governo_per_il_blocco_ degli_sfratti-104378621/ [Last Access on May 22nd, 2015].
2. \Marmot M, Allen J, Bell R, Bloomer E, Goldblatt P. WHO European review of social determinants of health and the health divide. Lancet 2012; 380(9846): 1011-29.
3. Soggiu ME, Vollono C, Bastone A. Valutazione dell’esposizione umana a contaminazione ambientale: scenari di esposizione. Roma: ISS, 2010 (Rapporti ISTISAN; 10/19).
4. http://dati-censimentopopolazione.istat.it [Last Access on May 22nd, 2015].
5. Krieger J, Higgins DL. Housing and health: time again for public health action. Am J Public Health 2002; 92(5): 758-68.
6. D’Alessandro D, Raffo M. Adeguare le risposte ai nuovi problemi dell’abitare in una società che cambia. Ann Ig 2011; 23(3): 267-74.
7. Braubach M. Key challenges of housing and health from WHO perspective. Int J Public Health 2011; 56(6): 579-80.
8. Capasso L, Basti A, Savino A, Flacco ME, Manzoli L, D’Alessandro D. Semi-basements used as dwell-ings: hygienic considerations and analysis of the regulations. Ann Ig 2014; 26(1): 3-9.
9. Capasso L, Flacco ME, Manzoli L, Basti A. Analisi delle differenze fra i requisiti igienico-sanitari dei sottotetti abitabili nelle diverse regioni italiane. Ann Ig 2013; 25(2): 159-65.
10. Capasso L., Varagnoli C, Vasti A, et al. Le deroghe ai resuisiti igienico-sanitaro nel recupero e nelle sa-natorie di civili abitazioni in Italia. Ann Ig 2014; 26(6): 553-8.
11. www.altalex.com/index.php?idnot=70428 [Last Access on May 22nd, 2015].
Corresponding Author: Prof. Daniela D’Alessandro, Gruppo di Lavoro Igiene Ambiente Costruito, Società Italiana
di Igiene, Medicina Preventiva e Sanità Pubblica, Viale Città d’Europa 74, 00144 Roma e-mail: daniela.dalessandro@uniroma1.it
